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Chapter 17. Perioperative Regional Anesthesia and Analgesia: Effects on Cancer Recurrence and Survival After Oncological Surgery

Which of the following is the main reason for cancer-related death?

A. Primary cancer

B. Metastatic recurrence

C. Comorbidity

D. Cancer treatment

B is correct. Metastatic recurrence, rather than the primary cancer, accounts for approximately 90% of cancer-related deaths.

Which of the following is not a recognized factor that contributes to metastatic spread?

A. Surgery

B. Regional anesthesia

C. General anesthesia

D. Opioid administration

B is correct. Regional anesthesia is not a recognized factor that contributes to metastatic spread. The evolution of cancer cells in local and metastatic recurrence depends largely on the balance between the host defenses and the tumor’s ability to seed, proliferate, and attract new blood vessels. However, at least three perioperative factors may influence this balance and contribute to metastatic spread: surgery, general anesthesia, and opioid administration. Regional anesthesia could preserve immune function and attenuate the stress response related to surgery and decreases the intraoperative use of volatile anesthetics and perioperative opioid. This combination of effects might allow enhanced preservation of perioperative immune function and potentially reduces the incidence of cancer recurrence.

Which of the following comments is true based on the current evidence?

A. Regional anesthesia may improve overall survival rate and reduce cancer recurrence following oncology surgery.

B. Regional anesthesia may improve overall survival but did not reduce cancer recurrence after oncologic surgery.

C. Regional anesthesia reduced cancer recurrence but did not affect overall survival rate after oncology surgery.

D. Regional anesthesia did not reduce either overall survival rate or cancer recurrence after oncology surgery.

B is correct. A recently published systematic review and meta-analysis included studies that compared the effects of regional anesthesia on cancer recurrence and mortality with those of general anesthesia. Results showed that perioperative regional anesthesia may improve overall survival following oncologic surgery (HR = 0.84, 95% CI 0.75 to 0.94, I2 = 41%). However, there was no positive association found between regional anesthesia and reduced cancer recurrence (HR = 0.91, 95% CI 0.70 to 1.18, I2 = 83%).

The use of opioids during surgery and pain management after surgery may contribute to metastatic spread due to:

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